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90 Peripheral Vascular Disease

Table 1: Medical Management

RISK FACTOR OPTIMIZATION DIABETES MELLITUS
Diabetes mellitus is a strong risk factor for athero-
SMOKING CESSATION sclerosis of both coronary and peripheral vessels.
Smoking is the most potent modifiable risk factor for Patients with diabetes and PAD have an amputation
the development of PAD. Observational studies have risk of 20% and 5 year mortality of 50%. Major factors
shown that the risk for MI, deaths and amputation is contributing to amputation in diabetic patients is lack
less in patients who quit smoking. It is recommend- of diabetes education and neuropathic symptoms.
ed that every physician emphasize the importance Though a aggressive HbA1c control reduces micro-
of smoking cessation in patients with PAD. Phar- vascular complications like neuropathy, retinopathy
macological interventions with nicotine replacement and nephropathy, macrovascular complications are
therapy such as nicotine transdermal patch, nicotine not affected. Hence a target HbA1c of < 7% is rea-
gum, nicotine spray or nicotine inhalers have cessa- sonable.
tion rates of 15% to 30%. Bupropion an antidepressant
has approximately 25% efficacy in cessation. Vareni- SYSTEMIC HYPERTENSION
cline, a partial nicotine agonist used to improve crav- Systemic hypertension is also a strong risk factor for
ings and withdrawal symptoms, is the most effective PAD. Antihypertensives should be given to lower BP
agent for smoking cessation at this time.
at least to less than 140/90 mm/hg. The TASC II and
JNC VII recommend for a more aggressive BP goal of

GCDC 2017